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Atypical Pituitary Adenoma: A Case Report
Atypical Pituitary Adenoma: A Case Report
Atypical Pituitary Adenoma: A Case Report
Khaled A1, Joarder MA2, Karim B3, Chandy MJ4, Nasir TA5
Abstract
A 56 years old diabetic hypertensive male was admitted through neurosurgery OPD with the
complaint of vision problems in the right eye for the last 1 and 1/2 years. Peri-metry reveals
bilateral temporal field defects and MRI examination showed a sellar and suprasellar mass
infiltrating the surrounding structures including cavernous sinus. Histomorphologically and
inmmunohistochemically, a diagnosis of atypical pituitary adenoma was made.
1. Consultant, Dept. of Histopathology, Apollo Hospitals Dhaka; 2. Specialist, Dept. of Neurosurgery, Apollo Hospitals Dhaka; 3. Registrar, Dept. of Neurosurgery, Apollo
Hospitals Dhaka; 4. Sr. Consultant, Dept. of Neurosurgery, Apollo Hospital, Dhaka; 5. Sr. Consultant, Dept. of Histopathology, Apollo Hospital Dhaka.
acuity of right eye 1/60 and left 6/9, perimetry Adenomas deriving from adenohypophyseal
shows temporal field defect: Right >left. Fundus parenchymal cells are classified as typical
examination reveals pallor of disc in both eyes. adenomas or atypical adenomas. In very rare
Intraocular pressure of both eyes was 20 mm of cases, they represent pituitary carcinomas
Hg. His hormonal level was serum cortisol (0.12%) of all cases.
10µg/dl, FT3 3.6 pg/ml, FT4 1 ng/dl and serum Diagnostic criteria (2004 WHO classification) of
prolactin 3.9 ng/ml. MRI examination of brain atypical adenomas include elevated MIB-1
and peroperatively, a sellar, supra sellar and proliferative index (3%), excess p53
parasellar mass Grade D and E infiltrating the left immunoreactivity, increased mitotic activity, and
cavernous sinus was seen. Transnasal pleomorphism. Although each of these factors
transsphenoidal tumour decompression was done has been independently associated with more
and tissue was sent for histopathology. aggressive and invasive neoplastic lesion, the
Microscopically, the tumour tissue shows accuracy of these diagnostic features taken
proliferation of uniform polygonal cells with collectively has not been assessed to date,
round nuclei arranged in nests, trabeculae and particularly in regard to degree of surrounding
sinusoidal pattern. In focal area, these cells show invasion and tumor recurrence rates.3
moderate pleomorphism with increased mitosis Atypical adenomas were found to have a poorer
(Fig.1). Immunohistochemistry reveal strong prognosis due to decreased operability by a
positivity for P53 and a diagnosis of atypical higher degree of invasiveness, larger size, and
pituitary adenoma was made. accelerated growth.4
Discussion It differs from pituitary carcinoma only in the
The aim of the current study was to present a case lack of metastases.4
with clinical, imaging, and histopathological Expression of p53 has been shown to correlate
characteristics satisfying the 2004 WHO criteria with the aggressiveness of pituitary adenomas
for atypical pituitary adenomas.3 and numerous other neoplastic lesions in selected
studies. Another study by Thapar et al. Analyzed
p53 expression in pituitary adenomas and
carcinomas, reporting the proportion p53 in
noninvasive adenomas, invasive adenomas, and
carcinomas to be 0%, 15.2%, and 100%,
respectively.5
In 2007, Saeger et al. reported their series of 4122
cases from the German Pituitary Tumour
Registry. In 2005, this registry reported 12 of 451
cases of atypical pituitary tumors for an overall
Fig. 1: Proliferation of tumor cells with
incidence of 2.7%.2
moderate pleomorphism and increased
mitosis. In a study by Scheithauer et al., which had
available follow up on 78 patients with